Healthcare Provider Details

I. General information

NPI: 1003005893
Provider Name (Legal Business Name): ENDOCRINOLOGY, DIABETES, AND THYROID CENTER OF ARIZONA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2007
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20100 N 51ST AVE SUITE F-635
GLENDALE AZ
85308-5125
US

IV. Provider business mailing address

20100 N 51ST AVE SUITE F-635
GLENDALE AZ
85308-5125
US

V. Phone/Fax

Practice location:
  • Phone: 623-266-7858
  • Fax: 623-444-9810
Mailing address:
  • Phone: 623-266-7858
  • Fax: 623-444-9810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number36320
License Number StateAZ

VIII. Authorized Official

Name: JASJEET KAUR
Title or Position: MD
Credential:
Phone: 602-885-7003